UHC HRA and 6 month preop requirements

educationrulz · December 10, 2009

HI everyone! This is my very first post on the forum. :thumbup: I've been reading posts for several weeks since I made the decision to get this surgery. I decided that instead of doing my usual routine of observing and reading forever (lurking), I'll just jump in and get as much preop support as I can from the great people on this site.

VSG has just been added to our WLS coverage options and I'm so excited. This is the only WLS that I've researched that hasn't scared the wits out of me. :biggrin0: I've started the ball rolling with my preop requirements by getting a psych assessment, scheduling my counseling sessions (I'm not the support group type), and getting my PCP on board with the requirement for 6 months of weight loss/nutritional documentation.

My question is, does anyone here have some insight on the documentation requirements for insurance coverage? I'm particularly interested in those with UHC policies, but would love to hear from those with other coverage as well. My main concern is being sure that I have the proper documentation for the nutritional/exercise components. My nurse coordinator explained to me that I could do something like weight watchers or go to my PCP and have them document my weight, diet, and exercise once a month for 6 months. I didn't see any point in paying for weight watchers when the PCP visits would be the same cost or cheaper.

When I talked to my doctor about it, he readily agreed to complete the documenation for me, but was kind of vague about it. He gave me a handout with a diet plan, so I guess that's what he'll document as my diet. They weigh me everytime anyway, so that's not a concern. But, I wasn't clear on how they'll document the exercise part. When I pushed the issue with the doc and asked how we would document the exercise, he just said something about me needing to do 30 minutes of exercise a day. I guess that's what he wrote in my chart. We all know how dismissive docs can be. I'm no shrinking violet, but I was sick when we we talked about this and was actually focused on my other health issues so I didn't push things as much as I could have.

After all this babbling, my point is that I want to know if anyone had any difficulty with this part of their documentation for WLS. Did the insurance company question this aspect of the info sent in? Did you have to go back and provide additional documentation? Or, was it pretty much the formality that it seems to be and that my PCP made it out to be? I plan to contact my nurse coordinator again to revisit this issue but I would love some insight from anyone here who has experience with this. My biggest fear right now is to go 6 months thinking I've done everything right and then get turned down over something so minor. (By the way, I still may add the weight watchers piece just to cover my bases.)

Happy to be here,

Mary

educationrulz · April 4, 2010

Just thought I'd bump this up in case anyone new has some relevant information on the final insurance approval process. I saw a blog on OH about someone who got approved through UHC in 3 days, so I hope it won't be too painful. I've been checking in with the surgeon's office and as of yet they haven't received the records we put in requests for. I'll have to follow up on this again in a couple of weeks so my insurance approval isn't delayed due to missing records.

cwalker · April 6, 2010

Hi, Mary...I submitted my 6 month supervised diet to uhc -thru my case manager. I faxed mine in on 3/15/2010 and went ahead with psychologial evaluation, my case manager called 04/01/2010 and said as far as she is concerned I am "done". She said the Dr office needs to call her for pre surgery notificiation. I have heard UHC was easy to work with, still keeping my fingers crossed nothing goes wrong. I was worried that the uhc case manager wouldnt accept the diet history as they had my height wrong but it wasnt a issue. good Luck.:001_smile:

educationrulz · April 6, 2010

Hi, Mary...I submitted my 6 month supervised diet to uhc -thru my case manager. I faxed mine in on 3/15/2010 and went ahead with psychologial evaluation, my case manager called 04/01/2010 and said as far as she is concerned I am "done". She said the Dr office needs to call her for pre surgery notificiation. I have heard UHC was easy to work with, still keeping my fingers crossed nothing goes wrong. I was worried that the uhc case manager wouldnt accept the diet history as they had my height wrong but it wasnt a issue. good Luck.:smile1:

That's good to hear. I talked someone at my doc's office yesterday and she indicated that all they will have to submit is the 6 MD notes from my PCP, the psych eval, the 6 counseling sessions, and the letter from the surgeon requesting approval. I've been driving myself crazy thinking I needed tons of documentation from every doctor I've ever seen. So, now I'm going to focus on tracking down the psychologist and getting the copy of my eval to the surgeon. Having no luck with that at all...:cursing: My advice to others on this issue would be to use a psychologist who works frequently with the surgeon you are going to use. It probably wouldn't be an issue then. But, I've got a month before it's time to submit my surgery request so I have no doubt that I'll get it done - even if I have to sit through another eval to expedite things.

Lookinupin2010 · April 6, 2010

UHC for me required the following:

5 year history of BMI of morbid obese

sleep study

psych evaluation

nutritional evaluation

blood work

cardiology release

pcp release with data on failed diet attempts in the past 5 years.

The paperwork was submitted on a Friday morning, and my approval came back the following Monday. I was told however, on the Friday that the paperwork was submitted that it normally takes UHC 2-4 weeks. I think that it might be because of when the 'meeting of approval board' meets. I just hit it lucky, I guess.

Hope all goes well with you...

cwalker · April 7, 2010

Well it took two days for us to connect over the caseworker info she needed, I don't want to pester the insurance lady, I just want to know what's going on, she has all the info so maybe(?) it will be submitted this week..then I guess insurance calls the Dr? or writes a letter, it's really tiresome after 2 months of nonstop hoop jumping. I know, patience is a virtue.lol:laugh0: